Shoulder Pain Treatment and Shoulder Pain Physical Therapy at DNR Shoulder pain is one of the most common musculoskeletal complaints. It can occur in any age group for various reasons. Most frequently pain results from trauma and overuse of the shoulder joint and surrounding tissues. Postures as well as ergonomics are also key factors in developing pain. Because of its unique anatomy, versatility and overall importance of the scapulo- humeral complex ( shoulder joint articulation) the treatment needs to be multilateral. Combining various medical disciplines is essential in order to achieve long-lasting positive effects. THE SHOULDER JOINT The structure and functionality of this joint are very unique. The anatomy of this joint is in fact the highlight of human evolution. The versatility and mechanics of motion is far more complex than of any existing precision machine. This most complex joint is one anatomical structure that showed marked morphological changes, compared to the corresponding area in closely related animals. The evolution of the human arm anatomy is intimately connected with development of human posture and locomotion. The posture and locomotion depend on neuromuscular coordination of scapulo-humeral girdle muscles as well as muscles connections with the spine and as far as contralateral hip. These develop in parallel, one slightly preceding another, during the postural ontogenesis that takes place in the first months of infant’s life mirroring the lengthy process of the human evolution. The stability of the scapula-humeral articulation during this time defines future posture and locomotion. In fact, the child is not able to walk until he can lift his arm above 120 degrees. WHY THIS JOINT IS SO FREQUENT SITE OF PAIN? It is a scientific fact that anatomical structures and functions, acquired the latest during the evolution, are the most fragile and prone to failures.
The human arm is a vivid example of that. The enhanced ability to perform complex multilateral movement has developed at the expense of diminished osteo-ligamentous stability, which is so important for all other joints in human body. Strong bone-and-tendon composition of the joint is replaced by an intricate, if delicate, muscular support mechanism known as the rotator cuff. The rotator cuff is designed to reinforce the otherwise unsupported joint and hold the ball-shaped head of the (humerus) in the glenoid fossa, the socket of the scapula.The cuff is made up of four muscles that originate from the scapula surface and are connected to the upper humerus forming a tight elastic blanket of muscle tissue over the joint of the arm holding it together. Without the cuff support, the head of the humerus would freely ride in and out of the shallow glenoid fossa, rendering the joint inoperable. ROTATOR CUFF Rotator cuff is not limited to structural support. Besides keeping the joint intact, it assists in movement of the arm. During a throwing motion, for example, muscles undergo series of rapid eccentric contractions (they are lengthened under tension) decelerating the arm and softening the impact of the exertion. Diverse functionality of this joint puts considerable stress on the tendons of these muscles making them susceptible to overuse and injuries. Relatively poor ability of the soft tissues in glenohumeral complex,to withstand excessive forces is frequently exacerbated by inadequate postural support of the glenohumeral and scapulohumeral muscles. The pain due to cuff tear, tendonitis, various arthritic inflictions and overuse are the price we pay for exchanging structural stability for mobility and motor versatility. WHAT ARE THE MOST COMMON SHOULDER PAIN SYNDROMES? â—? Rotator cuff tendonitis and tendinopathy â—? Rotator cuff impingement
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Rotator cuff tears Subacromial bursitis Frozen shoulder Bicipital tendonitis Labrum tears Rotator cuff calcific tendonitis
WHAT ARE THE PREDISPOSING FACTORS OF SHOULDER PAIN? Abnormal morphology (aberrant development of shoulder anatomy) ● ● ● ●
Poor posture Overuse Excessive overhead activities Repetitive trauma
HOW DOES POOR POSTURE CREATE SHOULDER PAIN? The function of this complex articulation depends not only on the integrity of rotator cuff muscles and sinews, but also on the stabilization of the scapula and its communication with the spinal engine. The ideal position of the scapula is achieved when the spine is erect. Poor posture impedes scapular stability, disturbs motor control generating excessive loads to the rotator cuff tendons. For example: Try to lift your arm sideways after slumping your thoracic spine or protruding your chin forward and then compare the results to the range of motion of the same movement during the erect spinal position. When you are slumped you will not be able to get your arm as high as when your spine is erect. HOW IS THE PAIN GENERATOR ESTABLISHED?
Clinical examination allows diagnostic certainty while further radiological investigation by diagnostic ultrasound, and/or MRI allows diagnostic precision. WHAT CONSERVATIVE METHODS CAN BE USED? The combination of specific shoulder physical therapy and rehabilitation exercise constitute scientifically proven and sound methods for shoulder pain treatment. Majority of these conditions respond well to a combination of extracorporeal shock wave therapy and proper shoulder pain physical therapy. Whatever the condition is at stake the combination of any of the above described methods and measured exercise brings the best results. HOW OFTEN IS THE SURGERY NECESSARY? Surgery is only necessary when the conservative therapy fails or after a destructive traumatic event. It is a responsibility of a conservative care clinician to make a timely referral for the surgery. WHAT KIND OF SHOULDER PAIN TREATMENT IS USED AT DYNAMIC NEUROMUSCULAR REHABILITATION? At DNR we use combination of physical therapy exercises, DNS (Dynamic Neuromuscular Stabilization) exercises and regenerative Shoulder pain treatment such as extracorporeal shockwave therapy. Depending on the diagnosis, individualized treatment plans are developed on an individual basis consisting of limitless combinations of the above-listed therapies. HOW DIFFERENT IS DNS APPROACH FROM CONVENTIONAL THERAPY? Most conventional shoulder pain therapy is based primarily on strengthening of the rotator cuff muscles. DNS approach is different in a way that the treatment begins with restoration of the motor control and muscular synergies before strengthening the cuff muscles. Doing this allows reestablishing muscular balance that is imperative for the ideal
function of the this joint. Muscle synergies that are established during the early childhood development serve as foundation of human posture and movement. During early development muscular synergies around the arm must develop first to ensure stability, which is critical for establishment of the first point of support by the child. DNS reenacts these muscular synergies, reestablishing muscle balance, responsible for ideal function of the joint prior to strengthening of the cuff. IS DNS TREATMENT ONLY USEFUL FOR ATHLETES? Professional athletes use DNS shoulder pain therapy and DNS exercises to prevent injuries and, should an injury occur, expedite post-traumatic recovery. There are numbers of elite athletes who use DNS therapy exclusively for rehab, injury prevention as well as performance enhancement. Roger Federer, Patric Haas, and Jaromir Jagr to name a few. Also few professional baseball teams use DNS therapy as prevention of arm injuries so common to baseball. However, the general application of DNS therapy extends far beyond sports medicine and is equally effective for all patient groups. WHAT IS REGENERATIVE SHOULDER TREATMENT? Regenerative treatment is a form of stimulation of body’s own regenerative abilities by different physical or biological agents introduced into the injured area. SHOULDER PAIN THERAPY ESWT – extracorporeal shockwave therapy is a treatment used for subacromial bursitis, rotator cuff tendonitis or shoulder calcific tendonitis. Please click here to explore our ESWT page… DNS specific shoulder pain physical therapy; as well as post-surgical rehab is a revolutionary approach available only in our clinic. We use above described methods in combination with ART (Active Release Therapy) in case there is an adhesion in the fascia of the scapula-humeral complex. At DNR we use focused low energy ESWT
unit in combination with radial EPAT unit for myofascial pain syndrome as well as for recovery of muscle tissue in athletes. Treatment of pain at the scapulohumeral or glenohumeral articulations must be multifaceted and timely because reduced arm swing can affect gait through contra lateral oblique chain inhibition, which disturbs gait by reducing opposite hip extension thus causing further damage to the locomotor system. The Shoulder pain Shoulder joint is the most intricate joint of the human body. The achieved freedom of movement in the shoulder in humans is at the expense of sacrifice to stability of the shoulder. Since we are not quadrupetals we are rarely it ever engage our upper extremity into closed kinetic chain activity, therefore proximal stability (neck, scapula, ribcage, spine) is sacrificed to distal mobility (dexterity and prehension) Functionally speaking most shoulder problems unless shoulder is affected by trauma are a result of poor posture, poor body mechanics and overuse. FOUR MAJOR CATEGORIES
● Soft tissue pain is the result of tendon irritation (tendinitis) or degeneration (tendinosis) and bursitis ● Instability ● Arthritis ● Trauma
SYMPTOMS
Shoulder pain may by deep and achy, pinpoint or widespread depending on the structures involved. Characteristically pain in the shoulder is worse with specific movement. DIAGNOSIS Albeit, having some of the best diagnostic technology available, we maintain that the clinical examination is the most important in arriving to the right diagnosis.
DIFFERENTIAL DIAGNOSIS
Clinical examination is usually sufficient to rule out major pathology. Diagnostic ultrasound is a modality of choice to screen out for rotator cuff tears, joint inflammation, tendon tears or inflammatory/degenerative states as well as bursitis. MRI is necessary when labrum tears or other complex joint pathology is present.
TREATMENT in NYDNR
The main stake of our treatment for shoulder disorders is a combination of manual therapy, DNS (Dynamic Neuromuscular Stabilization), extracorporeal shockwave therapy. Individualized treatment plans are developed on the individual basis consisting of balanced combination all of the above-listed methods.
SHOULDER CONDITIONS TREATED AT NYDNR
Shoulder impingement
Rotator cuff tendinitis/ tendinosis
Rotator cuff tears surgical and non-surgical approaches
Shoulder neck myofascial pain
Frozen Shoulder
Biceps tendinitis
Labrum tears
Shoulder instability
Shoulder arthritis
Post surgical rehabilitation
Physical Therapy for Shoulder Pain Share
Shoulder pain is a common condition that can be caused by any number of separate issues and can range widely in severity. The shoulder is one of the most important areas of the body, as it directly controls the range of motion in your arms. When this area is sore, completing standard tasks and activities can become much more frustrating to deal with and difficult to do. Causes of Shoulder Pain There are many causes of shoulder pain. Though it would take quite some time to compile all of the reasons that shoulder pain develops, there are several common causes that you should certainly be aware of. Simply being in a car accident that thrusts you forward can result in a whiplash injury that affects your shoulder. Any activities that are completed with overhead motions may also lead to the development of mild to severe pain in this area of the body. These activities include everything from throwing a football to swimming. When these activities are done on a repeated basis, the biceps tendons or rotator cuff can become pinched, which leads to notable shoulder pain. One of the less noticeable causes of shoulder pain is bad posture. The reason for this is because bad posture causes
a buildup of shoulder pain over a lengthy period of time. When the shoulder is hunched, stress builds up in the area and eventually leads to the development of pain. Any accidents that occur from slipping or falling may also lead to this pain. For instance, slipping in the shower could cause you to fracture a bone in the shoulder. Though it’s not one of the more common areas of the body that this condition affects, arthritis can also create pain in the shoulder. It’s also important to understand that shoulder pain can develop for no apparent reason at all. Thankfully, the types of shoulder pain that typically require treatment are the ones with apparent causes. Common Shoulder Problems There are several common shoulder problems that can lead to an increase in pain throughout the affected area. Tendonitis within the rotator cuff is one of the more painful problems, as it affects four muscles found in the shoulder. When the tendons just below the shoulder blade become pinched, they will become sore and inflamed. Tendonitis in the biceps tendon can cause a lot of shoulder pain and occurs due to the pinching of the shoulder blade. The biceps tendon is particularly important for providing stability to the shoulder. When it’s not working properly and in pain, you will be unable to complete ordinary tasks without difficulties. Another common shoulder problem is referred to as shoulder bursitis. The bursa is a sac that rests between the shoulder blade and humerus bone and is filled with liquid. This bursa helps greatly with movement in that area. When the bursa becomes pinched, you will experience a lot of pain. A fracture of the shoulder is one of the more serious problems you can experience and primarily occurs due to a severe car accident or fall. The three areas of the shoulder that can be hurt due to this injury include the humerus, collarbone, and scapula. The larger the extent of the damage is, the more
shoulder pain you will feel. Lastly, a frozen shoulder is a strange condition wherein your shoulder becomes increasingly painful over time, losing motion bit by bit. This problem can be devastating for doing everything from driving to writing a report. This condition has been known to last as long as 18 months. How to Treat Shoulder Pain If you’re wondering about how to treat shoulder pain that you’re currently going through, there are a myriad of treatments available for you to choose from. Since there are so many general causes for shoulder pain, these remedies aren’t a one-size-fits-all solution. Some treatments will work better than others depending on the reason for the injury in the first place. Due to the fact that many instances of pain in this area of the body can be explained by overuse of the shoulder, it’s important to understand that changing the way you perform certain activities may be effective at reducing the pain. This is particularly true of any activities you’ve recently done that you’re generally not accustomed to participating in. As is the case with any other type of exercise, performing that exercise too often will lead to overuse since the muscles in the shoulder have yet to adapt to the activity in question. If you’ve pinpointed a specific activity that has caused this pain, consider ceasing this activity until the pain has dissipated. Certain types of medication have also proven to be very effective at treating many types of shoulder pain. For instance, anti-inflammatory medications can help with both the pain and inflammation, while certain medications with numbing properties can be used to temporarily alleviate the pain that you’re experiencing. If you’re provided with a prescription for medication, it’s absolutely essential that you take only the recommended dosage. Standard painkillers have also proven to be a fantastic remedy for helping with the pain. The application of ice packs on a
regular basis should be considered, especially if the shoulder pain is a result of an injury to the area. How Physical Therapy Can Help For shoulder pain, physical therapy can assist dramatically in reducing the pain or eliminating it altogether. By visiting a therapist, a standard evaluation will be provided as a means of determining the exact therapies that will work best for the pain you’re suffering from. Each physical therapy plan is tailored to the individual in order to heighten the chances of success. You will first be asked about how your pain started and what factors have worsened or reduced your pain in the time that you’ve had it. The answers to these questions allows the therapist to identify the treatments that work best for your situation. The amount of motion and strength you currently have within your shoulder will be tested before any therapies begin. Several additional tests may be given in an attempt to identify how the pain started and the portions of the shoulder that are causing the pain. Once all of this has been determined, the physical therapy will start. No matter which types of therapies are used with you, all of them are designed as a means of slowly reducing both pain and inflammation. These therapies are highly successful and should display some quick results. If Shoulder Pain Persists or Worsens In the event that the pain you’re currently experiencing becomes worse than it was initially, you should immediately see a doctor about some of the more invasive treatment options open to you, such as surgery. In most cases, the pain will dissipate over a period of one to two months. Even in the first couple weeks of treatment, you should start to see some notable improvements to the levels of pain you’re going through. The most important thing you can do in the future is to keep your arm strong and stable. This reduces the chances of injury to the area and will ensure that your
shoulder stays pain-free. Shoulder mobility exercises can be very beneficial in this regard. https://nydnrehab.com/what-we-treat/shoulder-pain/nyc-new-york-c ity-shoulder-pain-treatment/